The Cost of Pedestrian Injuryin San Francisco

Dahianna Lopez, RN, MSN, MPHPrevention Director

The San Francisco Injury Centerand San Francisco General Hospital

City Operations and Neighborhood Services Committee Meeting11 April 2011

San Francisco Injury Center

• One of 13 CDC-funded Injury Centers• Affiliated with UCSF School of Medicine• Housed at San Francisco General Hospital• Diverse professional staff• Focus on research, prevention, policy, and

education in injury and hospital care

San Francisco General Hospital

• San Francisco’s only trauma center• Cares for all patients with traumatic injury in

San Francisco, regardless of ability to pay• A unique opportunity to study pedestrian

injuries

http://www.sfghf.net/about_sfgh.html

Scope of the Problem

• 650 – 750 auto-versus-pedestrian (AVP) injuries seen at SFGH yearly a

• Police collision records under-report pedestrian injuries by 21% when compared to hospital records b

• During 2008 alone:– In San Francisco, 92 injuries / 100,000 people– Nationwide, 63 / 100,000– Healthy People 2010 goal, 19 / 100,000 c

a Healthy People 2020 Public Meetings, 2009. http://www.healthypeople.gov/hp2020/b Sciortino et al., 2005. Accident Analysis and Prevention 37:1102-13.

c Dicker et al., 2011. Journal of Trauma, submitted.

Study Findings

• 3,598 cases found from 1/2004 to 12/2008– 952 (26%) patients admitted to hospital– 2,667 (74%) treated and able to go home

• Children (0 – 19y): 14%• Adults (20 – 64y): 72%• Elderly (>65y): 13%

Study Findings

• 74% lived in San Francisco at the time of injury• 7% homeless• <1% tourists

This issue affects primarily the residents of SF

A Day in the Life of an Injured Pedestrian

• Step 1: A pedestrian is involved in a collision with a vehicle• Step 2: An ambulance is sent to the scene

$1,200

A Day in the Life of an Injured Pedestrian

• Step 3: The patient is taken to SFGH, where an interdisciplinary trauma team stabilizes and treats the patient.

$6,405

A Day in the Life of an Injured Pedestrian

• Step 4: The patient is either treated and is well enough to be released, or is admitted to the hospital for further care.

• If admitted…(stay 1 – 2 weeks on average)

$72,754

Overall CostsCollision Year Total Cost Cost per Capita

2004 $12,819,457.91 $15.25

2005 $13,454,205.01 $16.01

2006 $16,540,064.94 $19.70

2007 $17,636,210.39 $20.98

2008 $15,326,148.94 $18.24

All years $75,776,087.19 $90.18

• 45% charged to MediCal/Medicare• 24% charged to private insurance• 16% to patients out-of-pocket• Overall, 76% charged to public funds

Cost expressed in 2008 dollars

Admitted Patients (Severe Injuries)

• Even though admitted patients only account for 25% of the total number of injuries, they account for over 75% of the total cost.

• Important to reduce severe injuries for social and economic reasons

Cost of Admitted Patients by District

Districts 1, 7, 11 (2004 - 2008)

District Severe Injuries

Death Medical Costs Lived in/Injured in

District1 (Mar) 56 7 $4.1 M 29%

7 (Elsbernd) 49 2 $5.1 M 31%

11 (Avalos) 69 5 $3.8 M 54%

Summary

• Pedestrian injury in San Francisco is a serious problem in terms of human and economic cost.

• The cost of not addressing this issue is economically and socially overwhelming.

Recommendations

• Allocate funding to support the pedestrian safety initiatives outlined in the Mayor’s Executive Directive 10-03

• Coordination of pedestrian data (injury, cost, environmental, planning, and engineering variables)

• Implementation of pedestrian safety countermeasures and initiatives that are informed by data – to have highest impact at locations with the greatest need.

Contacts & Acknowledgements

• Dahianna Lopez, RN, MSN, MPH• Prevention Director, San Francisco Injury Center at UCSF• lopezd@sfghsurg.ucsf.edu

• Rochelle Dicker, MD• Executive Director, San Francisco Injury Center at UCSF• dickerr@sfghsurg.ucsf.edu

• Wendy Max, PhD• M. Margaret Knudson, MD• Marci Pepper• Ian Crane• Matthew Kutcher, MD

• Centers for Disease Control and Prevention (CDC)

Study Methods

• Used hospital diagnostic codes to identify SFGH hospital visits for pedestrian injury

• Excluded San Mateo county injuries• Excluded intentional injuries• Patients divided into ‘admitted’ and ‘non-

admitted’

Hospital Stay for Admitted Patients

• Average hospital length of stay was 11.6 days• 30% of patients required ICU-level care, with an average

ICU stay of 2.8 days

• 55% of patients recovered enough to be discharged home

• 23% were discharged to another facility• 9% died in the hospital

• Years of potential life lost: 1,700

Cost of Admitted Patients in District 6

Year Severe Injuries Deaths Median

Age (y)Average Hospital Stay (d)

Total Injury Cost

2004 50 4 54 8 $2,298,389

2005 52 8 49 6 $1,684,418

2006 44 4 48 18 $4,469,125

2007 46 3 51 13 $3,141,306

2008 35 2 49 11 $2,124,586

All years 227 21 51 11 $13,717,826• 72-82% of these costs are charged to public

funds such as Medicare, MediCal, and Healthy SF

Cost expressed in 2008 dollars

Location of Injury

• Cross-referenced admitted patients with police reports using the StateWide Integrated Traffic Record System (SWITRS) to find location of injury

• Between ambulance records and SWITRS, location of injury was found in 77% of 931 admitted patients

• Used San Francisco Geographic Information System (SFGIS) to code injuries by district

Pedestrian Injury in District 6

• 74% of pedestrians injured in San Francisco live in the city at the time of injury

• 28% of those injured in District 6 live there• 36% live elsewhere in San Francisco

• As milder injuries not requiring admission were unable to be mapped, the actual cost in District 6 is substantially larger.